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Clinical Reasoning Strategies in Physical Therapy

I Edwards, PhD, Grad Dip Physio (Ortho), MAPA, is Physiotherapist, The Brian Burdekin Clinic, Adelaide, South Australia, Australia, and Lecturer, School of Health Sciences, University of South Australia.
M Jones, MAppSc (Manip Ther), Cert Phys Ther, Grad Dip Advan Manip Ther, MMPA, MAPA, is Senior Lecturer and Director, Graduate Programs in Musculoskeletal and Sports Physiotherapy, School of Health Sciences, University of South Australia
J Carr, Dip Physio, Grad Dip F Ed, is Physiotherapist, Murray Mallee Community Health Service, Murray Bridge, South Australia, Australia
A Braunack-Mayer, PhD, is Lecturer in Ethics, Department of Public Health, University of Adelaide
GM Jensen, PT, PhD, FAPTA, is Professor of Physical Therapy, Associate Dean for Faculty Development and Assessment, and Faculty Associate, Center for Health Policy and Ethics, School of Pharmacy and Allied Health, Creighton University, Omaha, Neb

Address all correspondence to Dr Edwards at School of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, Australia 5000 (ian.edwards{at}unisa.edu.au)

Background and Purpose. Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. Subjects. The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields. Methods. Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. Results. A model of clinical reasoning in physical therapy characterized by the notion of "clinical reasoning strategies" is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed "dialectical reasoning." Discussion and Conclusion. The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.

Key Words: Clinical practice • Clinical reasoning strategies • Decision making • Dialectical reasoning • Knowledge

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